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Helium-oxygen therapy for pediatric acute severe asthma requiring mechanical ventilation
Shamel A Abd-Allah1, Mark S Rogers, Michael Terry
1Pediatric Critical Care Division and Respiratory Care Department, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Insights
Helium-oxygen therapy in pediatric severe asthma patients on mechanical ventilation safely reduced peak inspiratory pressure and improved blood gas parameters. This treatment may be beneficial for critically ill children with acute severe asthma.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Emergency Medicine
Background:
- Severe asthma in children often necessitates mechanical ventilation.
- Managing these patients presents significant challenges in optimizing ventilation and gas exchange.
- Helium-oxygen (heliox) therapy is a potential adjunct for managing airway obstruction.
Purpose of the Study:
- To evaluate the efficacy and safety of helium-oxygen gas mixtures for pediatric patients with acute severe asthma requiring mechanical ventilation.
- To assess the impact of heliox on respiratory mechanics and blood gas parameters.
Main Methods:
- Retrospective review of 28 mechanically ventilated pediatric patients with severe asthma at a tertiary care children's hospital.
- Patients received helium-oxygen therapy after initial stabilization with conventional mechanical ventilation, bronchodilators, and corticosteroids.
- Data on peak inspiratory pressure, arterial blood gas pH, and partial pressure of carbon dioxide (CO2) were analyzed before and after heliox administration.
Main Results:
- Helium-oxygen therapy led to a significant decrease in mean peak inspiratory pressure (40.5 to 35.3 cm H2O).
- Significant improvements were observed in arterial blood gas pH (7.26 to 7.32) and a decrease in partial pressure of CO2 (58.2 to 50.5 torr).
- The therapy was associated with a mean of 5.0 days of mechanical ventilation and a mean hospital stay of 10.1 days, with two cases of pneumothorax.
Conclusions:
- Helium-oxygen administration is a safe therapeutic option for pediatric patients with severe asthma requiring mechanical ventilation.
- Heliox therapy can effectively reduce peak inspiratory pressures.
- This therapy may improve blood gas parameters, including pH and partial pressure of CO2, in this patient population.
Objective:
To illustrate the use of helium-oxygen gas mixtures as therapy for pediatric patients with acute severe asthma requiring conventional mechanical ventilation.
Design:
Retrospective review.
Setting:
Tertiary care children's teaching hospital.
Patients:
All mechanically ventilated patients with severe asthma admitted to the pediatric intensive care unit from August 1994 to October 2000.
Interventions:
Within 24 hrs of intubation or admission, patients were stabilized on volume ventilation, bronchodilator therapy, corticosteroids, and antibiotics when indicated. Hypercapnia was permitted while maintaining arterial blood gas pH > or =7.25. A helium-oxygen gas mixture then was begun with helium flow set at 5-7 L/min, and oxygen flow was titrated to maintain desired oxygen saturation. Only sedated, chemically paralyzed patients with adequate pre-helium-oxygen and post-helium-oxygen measurements were statistically analyzed.
Measurements And Main Results:
Twenty-eight mechanically ventilated patients with severe asthma placed on helium-oxygen gas mixtures were identified who met study entry criteria. Mean patient age was 8.8 yrs (range, 1.1-14.6). Before helium-oxygen therapy began, mean peak inspiratory pressure was 40.5 +/- 4.2 cm H(2)O, mean arterial blood gas pH was 7.26 +/- 0.05, and mean CO(2) partial pressure was 58.2 +/- 8.5 torr. After patients were placed on helium-oxygen therapy, there was a significant decrease in mean peak inspiratory pressure to 35.3 +/- 3.0 cm H(2)O. Mean pH increased significantly to 7.32 +/- 0.06, and mean partial pressure CO(2) decreased significantly to 50.5 +/- 7.4 torr. Initial mean inspired helium was 57 +/- 4% (range, 32-74). Mechanical ventilation days ranged from 1 to 23 days (mean, 5.0). Hospital stay ranged from 4 to 29 days (mean, 10.1), with an average pediatric intensive care unit stay of 6.9 days (range, 2-24). There were two incidences of pneumothorax.
Conclusions:
In the pediatric patient with severe asthma requiring conventional mechanical ventilation, helium-oxygen administration appears to be a safe therapy and may assist in lowering peak inspiratory pressure and improving blood gas pH and partial pressure CO(2).